ROBERTO DE CLEVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Left Ventricular Dilation and Pulmonary Vasodilatation after Surgical Shunt for Treatment of Pre-Sinusoidal Portal Hypertension(2016) SANTAREM, Orlando Luis de Andrade; CLEVA, Roberto de; SASAYA, Flavia Megumi; ASSUMPCAO, Marianna Siqueira de; FURTADO, Meive Santos; BARBATO, Alfonso Julio Guedes; HERMAN, PauloObjective The aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni. Location The University of Sao Paulo Medical School, Brazil; Public Practice. Methods Hemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1-distal splenorenal shunt (DSRS, n = 13) and group 2-esophagogastric devascularization and splenectomy (EGDS, n = 15). Results The cardiac output (5.08 +/- 0.91 L/min) and systolic volume (60.1 +/- 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05). Conclusions The late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.
conferenceObject BODY COMPOSITION AND RESTING METABOLIC RATE IN WEIGHT LOSS AFTER BARIATRIC SURGERY(2016) SANTO, M. A.; MOTA, F. C.; V, A. Gadducci; SANTAREM, G. C.; SILVA, P. R.; GREVE, J.; CLEVA, R.conferenceObject FALL PREVALENCE AND BONE METABOLISM IN OBESE ELDERLY PATIENTS UNDERGOING BARIATRIC SURGERY(2016) SANTO, M. A.; KANAJI, A. L.; ANDRADE, J. P.; PAJECKI, D.; CLEVA, R. de- Weight Regain After Gastric Bypass: Influence of Gut Hormones(2016) SANTO, Marco Aurelio; RICCIOPPO, Daniel; PAJECKI, Denis; KAWAMOTO, Flavio; CLEVA, Roberto de; ANTONANGELO, Leila; MARCAL, Lia; CECCONELLO, IvanThe Roux-en-Y gastric bypass (RYGB) is the gold standard bariatric operation. However, a major concern in late follow-up is the substantial weight regain. Understanding the role of gastrointestinal hormone secretion in this situation is relevant. The aim of the present study was to evaluate the influence of gastrointestinal hormones comparing postprandial secretion of ghrelin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and leptin between patients with weight regain and those with favorable weight control. Twenty-four patients with follow-up from 27 to 59 months were divided into two groups according to sustained weight loss: group A (14 patients) had sustained weight losses, and group B (10 patients) had significant weight regain. Basal serum levels of ghrelin, GIP, GLP-1, and leptin after fasting and 30, 60, 90, and 120 min after a standard meal were measured. There was no difference in the ghrelin secretion. There was a difference in the GIP secretion, with a higher percentage increase in 30 min in group A (330 % x 192.2 %; p = 0.01). There were also differences in the GLP-1 secretion, with higher increases in absolute (p = 0.03) and percentage values after 30 min in group A (124 % x 46.5 %; p = 0.01). There was also a difference between baseline leptin values, with higher levels in group B (p = 0.02). The secretion of gut hormones in patients with weight regain after RYGB is different from that in patients with satisfactory weight outcome. After meal stimulation, reduced levels of GIP and GLP-1 may indicate the influence of gut hormones in the process of weight regain.
- Use of noninvasive markers to predict advanced fibrosis/cirrhosis in severe obesity(2016) CLEVA, Roberto de; DUARTE, Livio Fiolo; CRENITTE, Milton Roberto Furst; OLIVEIRA, Claudia Pinto Marques de; PAJECKI, Denis; SANTO, Marco AurelioBackground: Nonalcoholic steatohepatitis is observed in 25%-55% of patients with severe obesity and in 2%-12% with bridging fibrosis or cirrhosis. There is currently no noninvasive test for the diagnosis of severe liver fibrosis before bariatric surgery. Objectives: To determine the best noninvasive test for predicting advanced liver disease in patients with severe obesity. Setting: University tertiary care hospital, Brazil. Methods: A cross-sectional retrospective study was conducted with 699 patients with severe obesity undergoing bariatric surgery: 568 without a biopsy (nonbiopsy cohort) and 131 patients who had undergone an intraoperative liver biopsy. The tissues were subjected to histologic diagnosis (Brunt criteria) and classified as advanced fibrosis (stages 3 and 4) or no significant fibrosis (absence of nonalcoholic steatohepatitis and stages 1 or 2). The following predictive indices of cirrhosis were calculated in all patients: aspartate aminotransferase/alanine aminotransferase ratio (AAR), age platelet (AP) index, aminotransferase-to-platelet ratio index (APRI), cirrhosis discriminant score (CDS), and hepatitis C antiviral long-term treatment against cirrhosis (HALT-C). The cutoff values, sensitivity, specificity, and areas under the receiver operating characteristic curves (AUROCs) were calculated for patients with biopsies. Results: The AUROC of the AAR, AP, APRI, CDS, and HALT-C model for predicting advanced fibrosis or cirrhosis were, respectively, .522, .88, .99, .905, and .921. The calculated cutoff values, sensitivity, and specificity, respectively, were as follows: AAR: .94, .7, .45; AP 5, .7, .93; APRI .44, 1.0, .97; CDS 6, .7, .97; and HALT-C: .76, 1.0, .77. Conclusion: APRI index was the best predictor of advanced liver disease in patients with severe obesity. (Surg Obes Relat Dis 2016;12:862-867.) (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
conferenceObject MANAGEMENT OF GASTROINTESTINAL LEAKS AFTER BARIATRIC SURGERY(2016) SANTO, M. A.; MOTA, F. C.; PAJECKI, D.; RICCIOPPO, D.; KAWAMOTO, F.; JOAQUIM, H.; BATISTA, A. C.; CLEVA, R.bookPart Obesidade e Cirurgia Bariátrica: Indicações e Resultados(2016) SANTO, Marco Aurelio; PAKECKI, Denis; RICCIOPPO, Daniel; CLEVA, Roberto de; CECCONELLO, Ivan- Influence of obesity and bariatric surgery on gastric cancer(2016) DANTAS, Anna Carolina Batista; SANTO, Marco Aurelio; CLEVA, Roberto de; SALLUM, Rubens Antonio Aissar; CECCONELLO, IvanEsophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.